LLS Ciitizen USA Study Shows Most Blood Cancer Patients Benefit from an Additional (3rd) COVID-19 Vaccine Dose

[lankisterguy]

The LLS National Patient Registry & The Leukemia & Lymphoma Society® (LLS) is a global leader in the fight against cancer.

lls.org/news/new-study-show...

Immune suppressing treatments-an essential component of many patient's cancer care-can blunt vaccine immune response

Rye Brook, N.Y., September 13, 2021 – More than one in two patients with B-cell blood cancers produced antibodies to a third dose of COVID-19 vaccine despite having no detectable antibodies after the first two doses, according to a new study from The Leukemia & Lymphoma Society (LLS). The study also showed that patients who had detectable antibodies after the first two vaccine doses had increased levels after the third dose. The study was published this week in the journal Cancer Cell (see full study cell.com/cancer-cell/fullte... and tables lls.org/sites/default/files... ).

“The additional COVID-19 vaccine dose appears to be improving immune response in many people with blood cancer—one of many conditions that can suppress a person’s immune system,” said Dr. Gwen Nichols, Chief Medical Officer at LLS. “However, while vaccination offers protection to the majority of blood cancer patients, some will not mount a full antibody response even with this additional dose.”

Get vaccinated, continue to take preventive precautions

LLS recommends that blood cancer patients who received two doses of either Moderna or Pfizer mRNA vaccine get an additional dose according to the Centers for Disease Control and Prevention (CDC) guidance for people who are moderately to severely immunocompromised. CDC has indicated that additional guidance will be forthcoming for patients who received the Johnson & Johnson’s Janssen COVID-19 vaccine. Until then, patients who received J&J or any other non-mRNA vaccine should consider an additional dose and talk to their healthcare provider.

LLS also advises all blood cancer patients to continue to layer on additional precautions like masking and social distancing to avoid becoming infected. Based on pre-vaccine data, patients with blood cancer tend to have more prolonged and severe COVID-19 infections compared to their healthy counterparts, including having significantly higher rates of death.

Study provides insights about the effect of immune suppressing treatments on immune response

Treatment with the antibody rituximab in the 6 to 12 months prior to vaccination was associated with a failure to produce detectable COVID-19 antibodies, even after a third dose of the mRNA vaccines. In addition, some patients on Bruton tyrosine kinase (BTK) inhibitors also fail to make detectable COVID-19 antibodies, though individual results in BTK inhibitor patients were more variable.

Current cancer treatment guidelines do not call for pausing these treatments or delaying COVID-19 vaccination in blood cancer patients. The best path forward is for blood cancer patients to consult with their health care team and to get vaccinated and to continue practicing other important infection prevention procedures recommended by the CDC.

Rituximab, which uniformly blunted immune response in this study, is also used to treat patients with rheumatic diseases, including rheumatoid arthritis (RA) and lupus. Studies in rituximab-treated RA and lupus patients have also shown low seroconversion rates in these patients following the first two doses of mRNA COVID-19 vaccines.

According to Dr. Jeffrey Curtis, chair of the American College of Rheumatology (ACR) COVID Vaccine Guidance Task Force, “patients receiving rituximab for rheumatologic conditions should speak to their provider about the timing of vaccination in relation to their rituximab dosing. As this LLS study and other rheumatology studies have shown, patients receiving rituximab may be at particularly high risk to not mount an antibody response after vaccination against COVID and following other vaccines. It is for this reason that the ACR Task Force suggested that optimizing the timing of vaccination for rheumatology patients on rituximab may yield an improved response to primary vaccination and supplemental (booster) dosing.”

Current study expands on earlier findings from the LLS National Patient Registry

An earlier study of more than 1,400 blood cancer patients enrolled in the LLS National Patient Registry reported that about one in four fail to produce detectable antibodies after two doses of either Moderna or Pfizer mRNA COVID-19 vaccines. However, these rates vary by cancer type, with non-Hodgkin Lymphoma (NHL) and chronic lymphocytic leukemia (CLL) patients less likely to have detectable antibodies.

Patients with these forms of cancer have a diminished response to vaccination because NHL and CLL can deplete the body’s B-cells. The body needs healthy B cells to fight infections and also to mount an antibody response to the vaccines.

Among the 38 patients with B-cell derived malignancies (almost all had NHL or CLL) in this latest study who were seronegative after two vaccine doses, 21, or 55%, had detectable antibodies after the third dose while 17 patients (45%) remained seronegative (Figure below). The 11 patients in the study who had measurable antibodies after the first two doses all had increased antibody levels after the third dose. Even in this difficult-to-immunize population, the study shows the majority (32 of 49, 65%) have detectable antibodies.

“Antibody levels in our study ranged from 2.2 to over 2,500,” says Lee Greenberger Ph.D., LLS Chief Scientific Officer. “Antibodies tell us that a patient has responded to vaccination—and that is a positive finding, but vaccine experts are still working to determine exactly what antibody level is needed to protect against COVID-19 infection or its worst outcomes.”

Greenberger also says antibodies are just one part of the story. He and his colleagues, including Dr. Larry Saltzman, LLS Executive Research Director are working on another study assessing blood cancer patients’ T-cell response to vaccines. The immune system’s T-cells are primed by vaccination to create “killer cells,” which are the first line of defense against infections like COVID-19. They are also analyzing antibody data from hundreds of additional patients who have received a third vaccine dose. T-cell results and an update to the current study are both expected later this year.

Based on the results of this and the earlier LLS study, LLS estimates that at least 100,000 blood cancer patients in the U.S. will not have detectable antibodies following three doses of mRNA vaccines.

For additional information visit lls.org/lls-newsnetwork. lls.org/lls-news-network

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Len

[lankisterguy Volunteer]

COVID-19 Vaccine 3rd Dose vs anti CD20 mabs

COVID-19 Vaccine 3rd Dose vs anti CD20 mabs.JPG

[lankisterguy Volunteer]

COVID-19 Vaccine 3rd Dose vs BTKis.

COVID-19 Vaccine 3rd Dose vs BTKis.

[Shrink]

Appreciate this post. Thank you !

[bennevisplace]

Thanks Len, this is good info, adding to findings of previous studies. Encouraging for many, but not for those of us who've been on a CD20 antibody like Rituximab (Rituxan) or Obinutuzumab (Gazyva) in the past couple of years.

I had my first dose of Ox-AZ vaccine 12 months after my final dose of Rituximab, within the FCR treatment regime, and my second dose 2 months later. My third shot (Pfizer BNT) will be tomorrow, 19 months after finishing Rituximab. Without knowing my current Ig levels, but with an ALC stuck at about 0.6 (600) for the past year, I doubt that I will have much of an antibody response even after shot #3, but I'm tempted to have them checked anyway.

[Poodle2]

Thanks, this is encouraging. Would have loved to see the numbers even higher but I guess something is better than nothing.

[Mcpill]

I had my bloods taken yesterday. I had the booster in August. In May I had no antibodies. As of yesterday :Positive results are greater than 0.8, with the upper bound listed as “> 2,500” or greater than 2,500. Those that receive a result of > 2,500 have a neutralising antibody response of at least 2,500 U/mL in dicating a very high antibody level. I am astonished and VERY happy. Just the boost I needed. Despite initial tests after my pancreactic surgery in June, the NET cells had in fact spread to my liver, I am now on chemo and praying that I will see some results.

[lankisterguy Volunteer]

I just got my LabCorp results after the 3rd shot on Aug 14 ( I had no adverse reaction to the shot) and I have been on Venetoclax 400mg daily for 5 years.

Labcorp COVID19 T spike antibody test results= >2500

[Bikram21 in reply to lankisterguy]

YABBA DABBA DOO! 💃

[E-Lynn]

Sorry Len to read you had not responded. You and I have been Venclexta twins, almost. I began several months after you (1/24/17). I've only had two moderna jabs and three Antibody tests, with my antibody numbers going up from (something like) 55 to 80 to 104 units per mL. Sadly, I have fallen into serious ITP (surprised by platelets of 34k then the next week 20k) so have put V on hold and am doing "rescue" work of IVIG and, lately, Dexamethason four day 40mg pulse which did not produce dramatic results but more labs tomorrow. I'm told not to get the booster until my ITP subsides. Of course, I'm wondering if my produced antibodies, not finding spikes, are settling for platelets. However, I haven't found anyone else going from jab then four months later, getting ITP.

[lankisterguy Volunteer in reply to E-Lynn]

Hi Lynn, I'm sorry I was not clear, I meant that I had no adverse reaction to the 3rd Pfizer shot, but my results are fantastic, my test came back above the maximum measurement. So I have more than 2500 T spike antibodies- up from 101 after the 2nds shot.

So I am very happy with that.

Venetoclax is doing just OK, my MRD tests are showing 0.30% CLL cells or 30 CLL cells out of 10,000 Leukocytes. I was MRD-U for almost 4 years, now creeping up slowly.

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Sorry to hear that you are having problems with ITP. I hope things turn around soon for you. As Brian K says "Stay Strong" or Spock "Live Long and Prosper"

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Len

[E-Lynn in reply to lankisterguy]

Fantastic re your booster response. Guess I shouldn't be reading so late in the evening. As I was 104 after 2nd jab, we may still be sort of twins on that. I'm hoping to get the booster soon. Today my platelets were 93k and if they hold or improve over the next few weeks, then perhaps I can get my booster. I'm also scheduled for another MRD test. It's been 3 years since my MRD-.

[kitchengardener2]

How very interesting, I shall be hoping for antibodies to appear after a third vaccine. I am five weeks into treatment with Acalabrutinib. After my first jab I had reduced lymph nodes and after a 2nd dose they reduced further. After 4 weeks of Acalabrutinib, the lymph nodes were hardly evident. I shall be hoping for good results.

[Doce]

I had 130 antibodies after my 2nd dose of Pfizer. I had a 3rd Pfizer shot in August and tested this week at >2500 antibodies. 2 years SLL watch & wait